Janssen’s quest to prevent diseases taking hold

Johan van Hoof, general manager of Janssen Vaccines & Prevention, on 'recalibrating' public understanding of illness

The Corpus Museum takes visitors on a beguiling journey through the human body, unlocking the complexities of anatomy along the way. It is a head-to-toe immersion in the physical wonders of life and its striking architectural design - half the building is a rust-coloured seated figure - can be seen for miles around.

It is a beacon to advances in medical knowledge but it also stands as a reminder of how the quest to comprehend and tame viruses, diseases and conditions is still a work in progress.

While tour parties were navigating the museum’s centre-piece of interactive intestinal and reproductive systems, Johnson & Johnson’s (J&J) senior scientific leaders were outlining a bold shift away from purely treating diseases to intercepting them before they take hold.

The company’s vision is a ‘World Without Disease’ by 2030 - a radical goal that requires a deep dive into the darkest recesses of biology.

“People live longer but they are not healthier. They have more diseases and, to cope with that phenomenon and to have a sustainable system, you really need to go beyond treatment and that is where prevention is important,” says Johan van Hoof, general manager of Janssen Vaccines & Prevention, who was part of a J&J panel showcasing the company’s future plans at a media day at the Corpus museum, near to its base in Leiden, The Netherlands, earlier this year.

“We will still focus on cures, of course, but we also want to be able to identify those patients who have high risks of becoming ill and treat them before they have symptoms, and ahead of that going into prevention which is where our vaccines come into play.

“Recalibrating public understanding and shifting behaviour will not happen overnight but we are going in that direction.”

Forest fires

The need to open up a different attack front is compelled by ageing populations afflicted by chronic and complex combinations of diseases that are sending healthcare systems into meltdown. As proof, van Hoof points to recent analysis from PwC’s Pharma 2020, The Vision, report which stated: ‘As the global population grows and ages, and demand for better healthcare management increases, the emphasis on treatment rather than prevention will become increasingly unsustainable.’

Identifying diseases at incubation stage - a volatile period of a disease evolution - will take a huge genetic decoding effort but van Hoof believes that a new range of biomarkers can be developed. “It will take time,” he adds. “But we can already identify children with a high risk of type 1 diabetes from certain antibodies, and there are extremely predictive biomarkers moving into cognitive problems such as Alzheimer’s, so the first wave of treatments will be in those areas. The clear vision is to have affordable tests.

“Prevention is more and more what the future is all about because of the malignant diseases we are seeing. If you apply interception principles in oncology for pre-malignant states, it’s like putting out little, almost invisible fires. If you pick up the right biomarkers we can deal with them before they become forest fires.”

Go faster

Vaccines will play a huge role in prevention, he adds, and many companies are pushing the boundaries of science to crack the codes of infectious and non-communicable diseases and to prompt powerful immune responses for early interventions.

The visionary thinking almost suggests that medical science and healthcare systems have maxed out their credit levels on blockbuster drugs and sharper business models to the point where only small gains are left. Van Hoof and J&J are insistent that the company remains committed to cures and transformational medicines - it is currently enjoying a rich run of form with major molecular breakthroughs - but that fresh insight is essential.

“Others are working on prevention but we are the ones who have crystallised it clearly. Governments and payers know that it makes sense to talk about this,” he adds. “How you do that is the challenge and new business models will be needed. EFPIA (the European Federation of Pharmaceutical Industries and Associations) is talking about performance-related schemes. I think we will get there because I don’t see many other options. I don’t know exactly how we will get there and maybe it will be a painful process and some countries might go faster than others.

“There will be small steps as the evidence builds up.”

Janssen, which has a bustling campus at Leiden incorporating Janssen Biologics, Janssen Vaccines, Mentor medical systems and the Janssen Prevention Centre, has been reshaping its structure to best serve its quest for greater biological insights and the mechanics to conquer diseases swiftly and efficiently.

“We want to be in fewer areas but focusing on the areas with huge need where we can make a difference,” says van Hoof, who has an illustrious R&D track record. “If you want to be transformational then you need to have a deep understanding of a disease and find the best size for it, internal or external, and combine it with operational excellence.”

Janssen’s acquisition of Crucell in 2011 brought it a suite of promising platforms covering HIV, a universal flu vaccine, respiratory syncytial virus (RSV), which is an infection of the lungs and respiratory tract that affects children and the elderly, and pathogens such as Ebola. It has the added bonus of being able to test vaccine candidates through its high-yield human cell line, which it can combine with its technology to create gene carriers that can be engineered for specific diseases to kick-start immunity.

This potent test bed has helped with development of its promising mosaic-based vaccine regimen for HIV which was reported at the 9th International Aids Society Conference on HIV Science in Paris in July this year.

Biomarkers

“The vaccine has been 10 years in the making and the regimen gives 94% protection if challenged once and up to 66% if challenged six times consecutively - a challenge deemed to be 200 times higher than human perspective,” adds van Hoof. “Many trials have failed, and the Thailand trial which was deemed a great step forward gave 34% protection, which is why there is such excitement. It looks like a paradigm shift for HIV as people with the right biomarkers can be taken off antivirals.

“We can all have disappointments but we are cautiously optimistic.”

The returns in terms of public health are immense: an estimated 37 million people around the world are living with HIV-1 and almost two million people become newly infected every year.

Its continuing work on Ebola has seen laboratory results that suppress the virus over 18 months and increased promise of an effective vaccine. And it drew praise for its rapid production of two million regimens in response to the outbreak in West Africa from 2014 to 2016.

The atmosphere of discovery at the Corpus museum is a catalyst for bold vision.

The J&J panel warmed to the theme and the concept of ‘immorbidity’ coined by the founder of the Janssen Prevention Centre, Jaap Goudsmit, to signify a state where people can enjoy their extended life expectancy free from the chronic illnesses that are currently shackled to the later years of many people. More than 50% of elderly people live with two chronic diseases and die with three or more but reversing that tide will clearly take more than visionary thinking, as healthcare systems have their viewfinders full of day-to-day adversaries swarming towards their creaking defences.

Although bolting together pharmaceutical, political and economic components can be frustratingly difficult and ponderous, there is more than just free thinking behind the new era of prevention, says van Hoof.

“I am optimistic about its progress,” he adds. “There is a feeling that many stakeholders think it is going in the right direction and the conditions are there to make it happen. I’m not so optimistic about the speed of change. There will be pilots that will fail and some people will be against it like with any change but I think the data will prevail and I am convinced this is the best way forward.

“We are not moving away from cures and it won’t happen in two or three years’ time. But it can be done and many people realise that it needs to be done.”